Hi kelpmermaid,
Let's talk about this kind of surgery, why the recession happens and what to expect.
First, the gum recession. I'm going to make an ASSUMPTION here...that you DON'T have gum disease. Instead, your recession is from physical stress on the teeth. Everything I tell you may be different if there is disease, ie., periodontitis, gingivitis, pocketing, pus.
I'm gonna give the "short" answer first because there is a lot that goes into the evaluation for the type of surgery.
There are several basic graft procedures. A pedicle graft, a free gingival graft and a connective tissue graft. Depending on the number of teeth, the amount of tissue needed and the location of "donor" tissue, any particular technique would be best.
This not like major gum surgery involving the bone, gums and teeth so discomfort is usually considerably less. Sometimes there is very little post op discomfort. There is little blood. Since there are two sites involved, in most cases, it can take time and there is a lot of fiddling around in a very little place.
For most, it is much easier than wisdom tooth extractions and there is no pushing and pulling like an extraction.
That's it, in a nutshell.
Now, the long answer...
Another meaning for the word Doctor is "teacher". As such, it is not only our job to provide a techinical service, we should also educate. We should always be a student. Anyone on this board with an MD, PHd, JD, DO, DDS, etc., is a doctor and is educating you with each answer. We also learn from you who ask questions and you who give their own experiences. That is also the reason for the first post at the top of the medical thread. We all teach and learn. This thread is not limited to responses by doctors.
Now the long answer.
Many people clench their teeth and the reasons vary from daily stress, anatomy of the jaws and teeth, interferences between opposing teeth that are not supposed to touch, habits, medications. This list goes on. Some people only clench (squeeze the teeth tightly together) and others brux (squeeze and rub the teeth)
We think of a tooth as a very hard object and it is. It is not infinitely hard. The bone surrounding the teeth can also vary in the strength they hold the teeth in with.
This next statement may seem strange but this is actually the way it works. Given a "contest" between teeth, bone and muscles, the muscles ALWAYS win! By that, I mean that the muscular act of clenching or bruxing can lead to several outcomes but the muscles are what actually direct the outcome.
There are several outcomes. For the purposes of simplicity, the soft bone means, less dense, thin, spongy, flexible, relatively flexible connection to the root. It would be a relatively easy extraction for a dentist.
Hard bone would be dense, thick, dense marrow space, inflexible and the connection to the tooth is quite solid. Extraction of the tooth would be more difficult.
Soft teeth would mean, small rooted and/or single rooted, small crown, softer enamel or dentin.
Hard teeth would be large or long rooted and/or multiple roots, large crown, hard enamel or dentin.
The hardness or softness is not an indicator of how decay prone the tooth is.
This is not terribly scientific although before an extraction, most dentists can tell if a tooth is going to be easy or difficult by looking at the x-rays and the teeth...perhaps testing their mobility.
1) Soft bone, hard teeth=teeth become mobile. Recession without much wear evident.
2) Hard bone, hard teeth=wear of the teeth...either on the chewing surface and/or around the necks of the teeth. A variant may be slight wear of the teeth but a lot of recession at the neck of the tooth, possibly with little wear at the neck of the tooth
There may also be bony projections in the middle of the hard palate and bony lumps on the inside of the lower jaw, usually on both sides and about half way back. Occasionally, there will also be a bony ridge that sticks out between the teeth and cheeks. These are called tori (torus is singular) or exostoses (plural).
Clenching is more likely to create tori and/or fractures and or pitting of the cusps of the teeth with no evident way the tooth surfaces come in contact. It looks like cupped out areas in the cusp tips. Recession is possible.
Bruxism is more likely to cause recession and/or ditching around the necks of the teeth. Fractured cusps are possible.
Both types of forces may also affect the jaw joints and that can result in TMJ syndrome, jaws that feel tired in the morning when waking, sensitive teeth, joint noises, joint pain, muscle pain, limitation of jaw opening or the inability to keep the mouth open for long without fatigue or discomfort.
Tori are a normal result of heavy muscular stress placed on the teeth and the body's attempt to strengthen the bone supporting the teeth by getting thicker in the areas with the most applied force. They normally do not require any treatment unless trauma to the tissue is occuring or you need dentures.
Fractured teeth may also occur--even if the tooth is not filled.
3) Soft bone, soft teeth=teeth become mobile and there may be wear on the teeth. Recession is possible at the necks of the teeth.
4) Hard bone, soft teeth=extreme wear of teeth on either the chewing surface and/or the neck of the tooth, recession next to the wear areas at the necks of the teeth. Fractured teeth.
5) Any intermediate combination of the above =any combination of the results.
The point is that the muscles create the stress and the bone and teeth respond by wear, movement, tooth position changes, sensitivity or joint changes.
Wear on teeth is catagorized into four types.
Attrition, abrasion, erosion and abfraction.
Attrition means the wearing away of tooth structure, usually by tooth tooth contact. It may be normal or pathologic.
Abrasion is the wearing away of tooth by abrasive causes like hard tooth brushing, a diet that may contain abrasive materials, working in an environment with abrasive dust.
Erosion is used to mean the chemical wearing away of teeth. Stomach acid or gastric reflux, bulemia, diets high in acidic foods like citrus, tea with lemon or water with lemon or soft drinks, etc. The enamel may appear dull rather than shiny. Some areas of the enamel may be worn into the underlying dentin.
Abfraction is the breakdown and loss of tooth structure and is a result of stress and strain placed on teeth. The wear can occur even in places that do not appear to rub together. What used to be called tooth brushing wear is now considered to be more likely abfraction with superimposed abrasion.
Abfraction often leads to cupped out or bean shaped depressions in different parts of the tooth. However, more angular lesions are still most probably caused by this and perhaps some abrasion by the toothbrush.
You can think of abfraction sort of like metal fatigue. Take a wire coat hanger, bend it back and forth enough and you will start to see small pieces of metal popping out. Finally, the metal breaks. Obviously teeth are not metal but they can flex microscopically. The flexing occurs where there is high concentrations of stress and strain. Slowly tooth structure is lost and wear is evident.
With harder or stronger teeth, the bone may not be able to withstand the forces. It begins to recede and the gums follow the bone.
Recession may also occur if teeth are moved too far to one side or the other of the supporting jaw bones during orthodontia or by a malocclusion that was NOT corrected by orthodontia. Dentistry is as much art as science and there is no way to actually know the perfect position for a tooth within the bone. The dentist is looking to create the best tooth to tooth contact possible that is in harmony with the jaw joints.
OK, now we are getting closer to your surgery question. You need to know about this first part because surgery helps correct the loss of tissue but it doesn't do much about the actual cause of the problem.
Now there are two types of gum tissue in the mouth. Attached tissue, which surrounds the teeth and mucous membranes of the cheeks, lips and the folds of the mouth.
The attached tissue is firm, keratinized and resists recession. It is supposed to surround all teeth. Some teeth don't have enough of it or have lost it to recession. If you have so little attached tissue around the tooth that it either can be pealed back to the mucous membrane OR mucous membrane is surrounding the tooth rather than the attached tissue, you are at risk of rapid recession and the loss of underlying bone. This can eventually lead to the loss of a tooth.
When you don't have enough Attached Tissue, you need a graft. The idea is to create as much attached tissue around the neck of a tooth with recession as possible to slow or stop further gum loss.
A graft does not change the stresses or anatomy which lead to the recession from occurring again. There are other ways to help correct this. That will be another chapter that I'm not gonna write for a while.
There are a variety of techniques for grafting.
If there is a lot of attached tissue immediately adjacent to the recession site, a Pedicle Graft may be used. Basically, you make a nick in the gum tissue and simply move it over the receeded area. It contains its own blood supply and works beautifully where it is possible. There is LITTLE discomfort. The tissue color usually is a perfect match.
The next type of graft is a "Free Gingival Graft. With this type, a small piece of gum from the roof of the mouth is "harvested" from a donor site and placed over a surgically prepared recipient site on the affected tooth or teeth. This is useful when there is insufficient tissue ajacent to the area needing the graft.
Generally, the area that becomes the most sore is the donor site. The site is sore because it's like a scrape and until the skin heals back over, the tissue is tender--sort of like a bad pizza burn and it can last longer.
The donated tissue is removed as a "block section...kind of a square or rectangle and sutured to place over the recipient site. The palate tissue may be a different color than the recipient area and it might be thicker than the recipient area. The result is that the graft has a block appearance for a while and may be a different color pink. This tissue can be contoured around the necks of the teeth to make the site appear to be normal.
This block section of skin is removed from its blood supply and must absorb nutrients from the underlying recipient site until it revascularizes. During the healing process, this donor tissue may appear to slough and look peculiar but most of these grafts "take".
A third type of graft is now being done more often. The Connective Tissue Graft. An inverted triangular piece of the palate is donated. Edges of the donated site can be sutured together and because it is closed, is much less uncomfortable.
A pouch is made between the layers of skin in the recipient area and the harvested connective tissue is tucked in and sutured to place. Again, the blood supply must re-establish but since it is surrounded on all sides, there is a high success rate.
The color is the same as the gum of the other teeth next to the recipient area because the graft is under the the skin with the "right" color.
Since it is tucked in, and sutured, there is little discomfort.
There are dressings and even surgical superglues that help seal the areas better now.
If there are ditches or erosions in the neck of the tooth by the graft site, have them restored first. A graft will not attach to a filling nor is that the point of the graft. You are trying to create a zone of attached tissue that resists recession better than what you originally had.
In the event you are clenching or bruxing and creating the recession and tooth wear, use a bite guard to reduce the force on the teeth.
The procedure is done under local anesthetic and the soft tissue is very easy to numb. The surgery won't hurt so don't worry about that.
You will probably need something for discomfort for a day or two and you may have to be careful about salty, spicy or cruncy foods for a few days.
Compared to other types of gum surgery, this is easier to tolerate. Compared to tough wisdom tooth impactions, it's a breeze.
If you are really nervous, the oral surgeon can sedate you. This procedure is commonly done by a periodontist. If that is the type of specialist you are going to, he may have nitrous oxide available. Some will use IV sedation but the malpractice rates are so high for this that most periodontists have stopped using anything other than nitrous oxide. Oral surgeons on the otherhand pretty much must be able to use IV sedation and/or general anesthesia and simply must pay the malpractice rates and charge accordingly.
The type of graft is determined by the anatomy of the area and the function it must serve. The surgeon has to determine this and I should not try to convince you to do it any particular way.
Now, everything I have just written is assuming HEALTHY gums and good oral hygiene. Recession due to gum disease is a different animal and I don't think it is appropriate to discuss this...there is too many possibilities.
Good luck...you're gonna do just fine. Don't worry so much...this is not brain surgery!
Laurence Stein DDS
:doctor:
Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)
